Commander's Guide to Combat Health Support US Army PAM-40-19
Commander's Guide to Combat Health Support
Army Pamphlet 40-19
24 March 1995
Unclassified
PIN: 073466-000
Change Summary
This new pamphlet contains information on the combat health support system. It is intended to be a guide for commanders of nonmedical units.
Title Page
PICTURE 1
History.
This UPDATE printing publishes a new informational pamphlet.
Summary.
This new informational pamphlet is published for commanders of nonmedical units. The information presented in this publication describes the combat health support system and how it interfaces with and provides support to the organization in wartime and peacetime.
Applicability.
This pamphlet is published for use by commanders of nonmedical units in the Active Army, the Army National Guard, and the U.S. Army Reserve. This publication is not applicable during mobilization.
Proponent and exception authority.
The proponent of this regulation is The Surgeon General. The proponent has the authority to approve exceptions to this regulation that are consistent with controlling law and regulation. Proponents may delegate the approval authority, in writing, to a division chief under their supervision within the proponent agency who holds the grade of colonel or the civilian equivalent.
Supplementation.
Supplementation of this pamphlet is prohibited without prior approval from Headquarters, Department of the Army (DASG-HCD), 5109 Leesburg Pike, Falls Church, VA 22041-3258.
Interim changes.
Interim changes to this pamphlet are not official unless they are authenticated by the dministrative Assistant to the Secretary of the Army. Users will destroy interim changes on their expiration dates unless sooner superseded or rescinded.
Suggested improvements.
The proponent agency of this pamphlet is the U.S. Army Medical Department Center and School. Users are invited to send comments and suggested improvements on DA Form 2028 (Recommended Changes to Publications and Blank Forms) directly to the Commander, U.S. Army Medical Department Center and School, ATTN: MCCS-FCD-L, Fort Sam Houston, TX 78234-6100.
Distribution.
Distribution of this publication is made in accordance with DA Form 12-09-E, block number 5377, intended for command levels C, D, and E for Active Army, Army National Guard, and U.S. Army Reserve.
Table of Contents
COVER Book Cover
CHANGES Change Summary
TITLE-PAGE Title Page
CONTENTS Table of Contents
FIGURES Figures
1.0 Introduction
1.1 Purpose
1.2 References
1.3 Explanation of abbreviations and terms
1.4 History of the Army Medical Department
1.5 Mission
1.6 Personnel
1.7 Quality assurance
2.0 Combat Health Support Within a Theater of Operations
2.1 Combat health support system
2.2 Modular medical support system
2.3 Echelons of combat health support
2.4 Theater hospital system
2.5 Hospital support requirements
2.6 Dental support in a theater of operations
2.7 Veterinary support in a theater of operations
2.8 Area medical laboratory
2.9 Theater evacuation policy
2.10 Intratheater evacuation policy
3.0 Combat Health Support Logistics
3.1 Combat Health Logistics System
3.2 Division Combat Health Logistics System
3.3 Corps Combat Health Logistics System
3.4 Echelons Above Corps Combat Health Logistics System
3.5 Medical equipment maintenance support
3.6 Optical Combat Health Logistics System
3.7 Blood management
4.0 Medical Intelligence
4.1 What is medical intelligence?
4.2 Health service intelligence resources
4.3 Combat health support planning in historical examples
4.4 Criticality of medical intelligence
5.0 Law of Land Warfare Provisions Affecting Medical Operations
5.1 Law of land warfare
5.2 Medical implications of Geneva Conventions
6.0 Personnel
6.1 Personnel Reliability Program
6.2 Physical profiling
6.3 Physical Performance Evaluation System
6.4 Medical Evaluation Board
6.5 Physical Evaluation Board
6.6 Professional Filler System
7.0 Training
7.1 Expert Field Medical Badge
7.2 Initial unit training and sustainment training
7.3 Combat lifesaver
7.4 Field sanitation team training
7.5 Medical proficiency training
7.6 The Joint Medical Readiness Training Center and the Combat Casualty Care Course
7.7 U.S. Army physician assistant
8.0 Soldier Health Maintenance/Current Health Problems
8.1 Soldier health maintenance elements
8.2 Sleep
8.3 Stress
8.4 Alcohol/drug abuse
8.5 Suicide prevention
8.6 Immunizations/prophylaxes
8.7 The Oral Health Fitness Program
8.8 Sexually transmitted diseases
8.9 Acquired immunodeficiency syndrome
8.10 Occupational safety and health
8.11 Field sanitation team
8.12 Army Aviation Medicine Program (flight surgeon)
8.13 Veterinary services
8.14 Nutrition
9.0 The Military Family
9.1 TRICARE
9.2 Civilian Health and Medical Program of the Uniformed Services
9.3 Primary Health Care for the Uniformed Services
9.4 Uniformed Services Dependents Dental Insurance Plan
9.5 Family Advocacy Program
9.6 Exceptional Family Member Program
9.7 Veterinary treatment facilities
A.0 Appendix A. References
GLOSSARY Glossary
USAPPC-INDEX Index
Figures
2-1. Echelons of combat health support 2.10
2-2. Component hospital system 2.10
1.0 Introduction
1.0 Introduction
Subtopics
1.1 Purpose
1.2 References
1.3 Explanation of abbreviations and terms
1.4 History of the Army Medical Department
1.5 Mission
1.6 Personnel
1.7 Quality assurance
1.1 Purpose
The purpose of this pamphlet is to provide commanders of nonmedical units with information on the combat health support (CHS) system. It is not intended to be all-inclusive but to provide a summary for the target audience. The information presented in this pamphlet is based on doctrine, policy, and procedures published in Army Medical Department (AMEDD) manuals.
1.2 References
Required and related publications and referenced forms are listed in appendix A.
1.3 Explanation of abbreviations and terms
Abbreviations and special terms used in this pamphlet are explained in the glossary.
1.4 History of the Army Medical Department
a. Today's medics trace their history back to the siege of Boston in 1775 under the leadership of George Washington. At Washington's request, the Continental Congress established the "hospital," which was the forerunner to the AMEDD. The AMEDD was not permanently established under that name until 1818. The physicians of the AMEDD did not receive the status of commissioned officers until 1847, but they had gained a reputation for efficient service and high professional standards well before then. As early as 1827, the Inspector General of the U.S. Army noted that the service "is truly fortunate in having such a medical corps . . . how could it be that the government was able to employ such professional worth at so paltry a price?"
b. The AMEDD lacked a supporting staff of specially trained enlisted men to aid the surgeons in preserving the health of the troops. Although in 1838 Congress had authorized the enlistment of men for exclusive duty as hospital stewards, it reversed this policy in 1842. To meet the needs of the AMEDD, Surgeon General Thomas Lawson had established a training school for hospital stewards in 1840. In 1844 Lieutenant General Winfield Scott, Commanding General of the Army, ordered that all soldiers detailed temporarily from their units for service as hospital stewards should remain officially attached to the hospitals throughout their service. Lieutenant General Scott's order forced the training school for hospital stewards to close for lack of eligible students. In 1887 a hospital corps was established to provide a standing body of educated, permanently assigned, enlisted personnel for service with the AMEDD.
c. During the late nineteenth and early twentieth centuries, the AMEDD also provided officers who made major contributions to the other branches of the Service. While stationed at Fort Davis, Texas, during the 1850's, Surgeon Albert J. Myer became interested in the problems of field communications using flags and torches. He presented his study on the subject to the War Department, and in 1863 became the first chief of the newly created Signal Corps. Organizational skill and a passion for systematic procedures won Surgeon Fred C. Ainsworth appointment first as acting Secretary of War and later as Adjutant General of the Army in 1907. During the same period Surgeon Leonard Wood, a Medal of Honor recipient for earlier service in the Indian Wars, shattered all precedent by becoming Chief of Staff of the Army.
d. The drive for professional excellence through education continued in the AMEDD. On 28 April 1920, Surgeon General Merritte W. Ireland addressed a letter to the Adjutant General requesting permanent authority to use the U.S. Military Reservation at Carlisle Barracks, Pennsylvania, as a field school. In June 1920, the Medical Field Service School (MFSS) was officially established at that post.
e. The school at Carlisle Barracks consisted of five departments: military art, enlisted training, hygiene, administration, and equipment and transportation. The school started with a basic course for medical, dental, and veterinary officers of the Regular Army. It soon added courses for Reserve and National Guard officers and noncommissioned officers (NCOs). It also added summer training for officers of the Reserve and the Reserve Officers Training Corps.
f. Some notable activities other than training were carried on at Carlisle. One was the equipment laboratory, which experimented with new equipment used in the treatment and evacuation of casualties. The first-aid dressing carried today by every soldier, once called the Carlisle dressing, was developed in that laboratory. Tentage for field hospitals (FHs), electrical equipment, improved litters, field dental dispensaries, new ambulances, field x-ray equipment, and many other items of medical equipment used by the Army were developed there.
g. The helicopter's potential for rapid evacuation of casualties from battlefields to hospitals, where prompt and definitive surgical care is available, was demonstrated first at Carlisle Barracks in 1935.
h. In 1940, as the nation mobilized for World War II, the AMEDD expanded and the school geared its activities to new requirements. Facilities and space at Carlisle Barracks were lacking to support expansion, large-scale field exercises, and demonstrations. The end of World War II saw selection of a larger site for the school--Fort Sam Houston, Texas. In 1946, the school moved from Carlisle Barracks to the new site where it became an organizational element of Brooke Army Medical Center (BAMC).
i. In training medical department personnel for their mission, the school enlarged its facilities and expanded and adapted courses of instruction to support changing requirements for field medical service. The U.S. Army Health Services Command (HSC) was established on 1 April 1973; this command consolidated many elements (including 36 post hospitals and 7 medical centers) of the continental United States (CONUS) AMEDD under a single major Army command. Concurrently, BAMC was reorganized as two commands under HSC: a medical center (designated BAMC), and several education/training elements (including the discontinued MFSS) consolidated under an Academy of Health Sciences (AHS), U.S. Army. Major new AHS facilities were completed; and, nearly 20 years later, on 1 July 1991, the AHS was redesignated as the AMEDD Center and School (AMEDDC&S). As a reaction to increasing medical centralization as well as post-Cold War developments, realignments accelerated; and, on 1 October 1994, HSC was redesignated and expanded as the U.S. Army Medical Command (MEDCOM)--a worldwide major command led by The Surgeon General.
j. The basic objectives of the first school were to train medical personnel to recover wounded from the battlefield and to treat them rapidly and effectively. These two elements of military medicine are studied as exhaustively today as they were in that first class at Carlisle Barracks.
1.5 Mission
a. The mission of the AMEDD mirrors the medical mission of the Department of Defense (DOD):
(1) To provide and maintain readiness to provide medical services and support to the armed forces during military operations.
(2) To provide services and support to members of the armed forces, their dependents, and others entitled to DOD medical care.
b. The AMEDD has responsibility for all medical services provided within the Department of the Army (DA). These services include--
(1) Patient evacuation and medical regulation.
(2) Hospitalization.
(3) Combat health logistics/blood management.
(4) Dental services.
(5) Veterinary services.
(6) Preventive medicine (PVNTMED) services.
(7) Combat stress control (CSC) services.
(8) Area medical support.
(9) Command, control, communications, computers, and intelligence.
(10) Medical laboratory services.
(11) Garrison outpatient services.
(12) Coordination of complementary health services among other Federal and civilian agencies.
1.6 Personnel
The AMEDDC&S trains both officer and enlisted personnel in a variety of medical functional areas and medical military occupational specialties (MOSs). Some of these medically trained officer and enlisted personnel may be assigned to a medical platoon organic to your battalion.
a. Officer personnel. Officers normally assigned to a medical platoon include Medical Corps (MC) officers (physicians), Medical Service Corps (MS) officers, and Army Medical Specialist Corps (SP) physician assistants (PAs).
(1) The MC officer has three major areas of responsibility. The first responsibility is to serve as platoon leader of the medical element of the battalion (medical platoon leader). The second responsibility is to serve as the medical advisor and special staff officer to the battalion commander. The third responsibility is to treat patients. Other responsibilities and functions of the battalion medical platoon leader include--
(a) Planning and directing unit-level CHS of the battalion.
(b) Assisting the Operations and Training Officer (S3) in planning and supervising individual and collective training of the medical platoon/section and in training nonmedical personnel within the battalion.
(c) Advising the battalion commander and staff on the current health of the command.
(d) Supervising the administration, discipline, equipment maintenance, supply functions, organizational training, and employment of the assigned medical element.
(e) Treating casualties.
Note. In the absence of the physician or when there is none assigned, the physician's duties and responsibilities, except the treatment of patients, will be assumed by the senior commissioned officer. The treatment of patients will remain with the patient treatment protocol.
(2) The MS officer (field medical assistant) serves as the medical operations officer and is responsible for the operational readiness of the medical platoon. The responsibilities and functions include but are not limited to--
(a) Coordinating CHS operations with the battalion S3.
(b) Coordinating nonmedical supplies with the headquarters and headquarters company supply personnel.
(c) Coordinating patient evacuation and medical resupply with the supporting medical company.
(3) The PA, while not a physician, is a skilled clinician who, by formal training and experience, is qualified to perform medical tasks formerly undertaken only by a physician. This individual functions in the battalion medical platoon under the direction and technical supervision of the medical platoon leader. The PA, in conjunction with the platoon leader, is responsible for--